Economic consequences of investing in anti-HCV antiviral treatment from the Italian NHS perspective : a real-world-based analysis of PITER data

OBJECTIVE: We estimated the cost consequence of Italian National Health System (NHS) investment in direct-acting antiviral (DAA) therapy according to hepatitis C virus (HCV) treatment access policies in Italy. METHODS: A multistate, 20-year time horizon Markov model of HCV liver disease progression was developed. Fibrosis stage, age and genotype distributions were derived from the Italian Platform for the Study of Viral Hepatitis Therapies (PITER) cohort. The treatment efficacy, disease progression probabilities and direct costs in each health state were obtained from the literature. The break-even point in time (BPT) was defined as the period of time required for the cumulative costs saved to recover the Italian NHS investment in DAA treatment. Three different PITER enrolment periods, which covered the full DAA access evolution in Italy, were considered. RESULTS: The disease stages of 2657 patients who consecutively underwent DAA therapy from January 2015 to December 2017 at 30 PITER clinical centres were standardized for 1000 patients. The investment in DAAs was considered to equal €25 million, €15 million, and €9 million in 2015, 2016, and 2017, respectively. For patients treated in 2015, the BPT was not achieved, because of the disease severity of the treated patients and high DAA prices. For 2016 and 2017, the estimated BPTs were 6.6 and 6.2 years, respectively. The total cost savings after 20 years were €50.13 and €55.50 million for 1000 patients treated in 2016 and 2017, respectively. CONCLUSIONS: This study may be a useful tool for public decision makers to understand how HCV clinical and epidemiological profiles influence the economic burden of HCV

Measurement and control of geo-location privacy on Twitter

The widespread diffusion of Online Social Networks and Media (OSNEM) has generated a huge amount of users’ personal data. As this data is often publicly available, users’ privacy is at risk. To address this issue, users may control the release of their sensitive data on OSNEM. An example of data that users rarely publish is their location. Besides being a privacy-sensitive information, location is a business-relevant data that third parties, e.g., Location-Based Service (LBS) providers, may be interested to obtain. It is, therefore, of paramount importance to understand to what extent the secrecy of location information can be violated. In this work, we investigate how users can measure the privacy of their geo-location on OSNEM and to control the factors affecting it. We define the privacy of a target user as the geographical distance between her actual unexposed location and the location estimated by an attacker. To measure privacy, we propose a novel deep learning architecture that uncovers a target user’s position based only on the publicly-available locations shared by users on Twitter. Results show that locations can be accurately unveiled for the majority of the users, thus suggesting the need for countermeasures to improve their privacy. To control privacy, we propose data perturbation techniques that users can apply to tune the public exposure of their location, and we show the resulting privacy improvements. To shed light on the factors influencing privacy, we then propose a machine learning model that measures privacy based on several users’ features (e.g., social and behavioral characteristics). Unlike the aforementioned deep learning approach, this model also allows to quantify the impact that each feature has on privacy. We observe that features related to the history of users’ visited locations proved to be the most relevant factors affecting privacy. Finally, we explore potential side effects resulting from the application of data perturbation strategies. In particular, we examine, as a study case, the trade-off between users’ privacy and the effectiveness of a proximity marketing LBS. Results suggest that privacy can be guaranteed while not significantly lowering the effectiveness of the LBS

The biceps brachii role in the stabilization of the cross punch

Purpose: starting from an injury background, we assumed that the biceps brachii\u2019s activations could have an important role in upper limbs injury. In this work we analyzed whether different activations of the biceps brachii impact on the power transfer of the punch and how boxers of different skill levels activate the biceps brachii when deliver a punch according to their skill level and efficacy. Methods: we enrolled, basing on official rankings, 23 skilled (n=6) and unskilled boxers. Subjects were instructed to perform three cross punches directed to a fixed elastic target triggered by the coach whistling, and were monitored through a surface electromyography sensor (EMG) on the biceps brachii to estimate the muscular activation during the performance, and through an accelerometer placed inside the elastic impact target to estimate the impact energy. We analyzed the oscillatory content of the EMG signal in order to assess the muscular activation between skilled and unskilled boxers, and between weak and strong punches. Results: both skilled and unskilled boxers threw strong, medium and weak strikes. Skilled boxers performed better than unskilled boxers (47% vs 25% in the \u201cstrong punch\u201d category).The EMG analysis revealed a significant increase of lower and higher frequencies (2-4 Hz and 15-17 Hz) and a decrease on the medium frequencies (7-9 Hz) in the skilled boxers compared to the unskilled boxers in strong punches. Weak punches had a similar activation patterns in the two groups. Conclusions: our results support the hypothesis that skilled boxers adapt their activation pattern of the biceps to better stabilize the punch delivery (and thus increasing the transfer of force)

Comparison of activity monitors accuracy to estimate energy expenditure of daily living activities

Accurate assessment of the total amount of physical activity (PA) or the energy expenditure (EE) in free living condition is a big challenge. A priority has been placed on the study of valid and reliable measures for all levels of PA. New technologies are available for objectively measuring PA and inferring EE: the Actiheart -AH-(Cambridge Neurotechnology, UK) and the SenseWear Pro2 ArmbandTM -SWA-(BodyMedia, USA) are an example of these new devices. PURPOSE The purpose of the present study was to examine the validity of these two new devices during light (<3 METS) to moderate (3-6 METS) and vigorous (>6 METS) intensity daily living activities in laboratory and feld settings. METHODS: 8 physically active women volunteered to participate in the study and performed in two separate days different activities: resting, occupation, housework, conditioning and recreation. Oxygen consumption was measured continuously throughout the routine by indirect calorimetry -IC- (K4b2, Cosmed, Italy) and participants wore the Actiheart on the chest and the Armband on the right arm for simultaneous estimation of EE (METS). RESULTS The combined AH model (Branched model: activity counts+HR) had the strongest relationship with PAEE (r=0785, p<0001) compared with those from the single-measure models (r=.748 and .719, p<0001 for the activity model and the HR model respectively), so that we only used this equation model to compare data with SWA and IC. The two analyzed methods were highly correlated with IC (AH r=.785 and SWA r=.795, p<0001) even if PAEE expressed in METS resulted significantly different for both devices (p<0.001 for AH and p<0.001 for SWA). The positively correlated errors with measured PAEE in the plots of both AH and SWA models indicate a systematic error in these equations (mean difference between methods= AH 1.52±2.38, SWA -0.11±2.48; 95% limits of agreement= AH -3.24 to 6.28, SWA -5.07 to 4.85). On the contrary the explained variances from the AH were lower if light intensity exercises are considered. CONCLUSION The AH provides reliable estimates of EE for light intensity activities; on the contrary it underestimates moderate and vigorous activities. The SWA has a lower systematic error in moderate and vigorous exercises. Both devices can provide a valid measure of the time spent in various intensity categories

Importance of the Actiheart individual calibration to estimate energy expenditure during field activities

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Human leukocyte antigen polymorphisms in Italian primary biliary cirrhosis: A multicenter study of 664 patients and 1992 healthy controls

Genetic factors are critical in determining susceptibility to primary biliary cirrhosis (PBC), but there has not been a clear association with human leukocyte antigen (HLA) genes. We performed a multicenter case-control study and analyzed HLA class II DRB1 associations using a large cohort of 664 well-defined cases of PBC and 1992 controls of Italian ancestry. Importantly, healthy controls were rigorously matched not only by age and sex, but also for the geographical origin of the proband four grandparents (Northern, Central, and Southern Italy). After correction for multiple testing, DRB1*08 [odds ratio (OR), 3.3; 95% confidence interval (CI), 2.4-4.5] and DRB1*02 (OR 0.9; 95% CI 0.8-1.2) were significantly associated with PBC, whereas alleles DRB1*11 (OR 0.4; 95% CI 0.3-0.4) and DRB1*13 (OR 0.7; 95% CI 0.6-0.9) were protective. When subjects were stratified according to their grandparental geographical origin, only the associations with DRB1*08 and DRB1*11 were common to all three areas. Associated DRB1 alleles were found only in a minority of patients, whereas an additive genetic model is supported by the gene dosage effect for DRB1*11 allele and the interaction of DRB1*11,*13, and *08. Lastly, no significant associations were detected between speci fic DRB1 alleles and relevant clinical features represented by the presence of cirrhosis or serum autoantibodies. In conclusion, we confirm the role for HLA to determine PBC susceptibility and suggest that the effect of HLA is limited to patient subgroups. We suggest that a large whole-genome approach is required to identify further genetic elements contributing to the loss of tolerance in this disease. Copyright © 2008 by the American Association for the Study of Liver Diseases

Pegylated interferon α plus ribavirin for the treatment of chronic hepatitis C: A multicentre independent study supported by the Italian Drug Agency

168nononeBackground: Data on the efficacy of Peg-interferon/ribavirin therapy for chronic hepatitis C are mostly derived from treatment of selected patients enrolled in clinical trials. This study aimed to assess the effectiveness of Peg-interferon/ribavirin therapy in "real world" chronic hepatitis C patients in Italy. Methods: Independent observational multicentre study including consecutive patients receiving Peg-interferon/ribavirin in the 18 months before (retrospective phase) and after (prospective phase) the start of the study. Results: 4176 patients were eligible. The final study population consisted of 2051 patients in the retrospective and 2073 in the prospective phase.Sustained virological response was achieved by 1036 patients (50.5%) during the retrospective phase: 325 were genotypes 1/4 (34.1%) and 684 were genotypes 2/3 (67.2%) and by 800 patients (38.6%) during the prospective phase: 300 were genotypes 1/4 (28.4%) and 473 were genotypes 2/3 (51.5%).During multivariate analysis genotypes 2/3 were significantly associated with higher sustained virological response rates; cirrhosis and γ-glutamil-transpeptidase >2 times the normal limit were associated with poorer response. Conclusions: The response to Peg-interferon/ribavirin therapy in "real world" clinical practice is distinctly lower than in registration trials. The difference in response rates was more pronounced among easy-to-treat than among difficult-to-treat hepatitis C virus genotypes. © 2014 Editrice Gastroenterologica Italiana S.r.l.Rosina, Floriano; Tosti, Maria Elena; Borghesio, Elisabetta; Masocco, Maria; Mele, Alfonso; Coppola, Carmine; Milella, Michele; Borgia, Guglielmo; Andreone, Pietro; Koch, Maurizio; Zignego, Anna Linda; Romano, Mario; Carrara, Maurizio; Almasio, Piero Luigi; Azzola, Emilio; Nardone, Gerardo; Benedetti, Antonio; Carosi, Giampiero; Mazzotta, Francesco; Sagnelli, Evangelista; Rizzetto, Mario; Mascolo, M.C.; Cursaro, C.; Scuteri, A.; Crespi, C.; Gianstefani, A.; Ranieri, J.; Monti, M.; Corti, G.; Blanc, P.L.; Baragli, F.; Bellentani, S.; Gasbarrini, A.; Pompili, M.; Mecenate, F.; Picardi, A.; Vespasiani, U.; Nosotti, Null; Gasbarrini, A.; Pompili, M.; Mecenate, F.; Null, A.Picardi; Nosotti, Null; Ricci, G.L.; Paffetti, A.; Mastropietro, C.; Moretti, A.; Spagnolo, A.L.; Puoti, C.; Bellis, L.; Regazzetti, A.; Maffezzini, E.; Pietrangelo, A.; Abbati, G.; Borghi, A.; Sardini, C.; Raimondo, G.; Scribano, L.; Martines, D.; Svegliati Baroni, G.; Faraci, G.; Schi-anchi, S.; Fornaciari, G.; Massari, M.; Fabris, P.; Bertin, T.; Salvagnini, M.; Madonia, S.; Calì, A.; Civitavecchia, G.; Pirisi, M.; Smirne, C.; Andreoletti, M.; Morisco, F.; Caporaso, N.; Gentile, I.; Brancaccio, G.; Gaeta, G.B.; Liberti, A.; Iannece, M.D.; Rocco, A.; Federico, A.; Loguercio, C.; Riegler, G.; Esposito, P.; Fargion, S.; Fatta, E.; Masutti, F.; Bonaventura, M.E.; Autolitano, A.; Russello, M.; Bellia, A.; Toniutto, P.; Bitetto, D.; Pasulo, L.; Lucà, M.G.; Grattagliano, I.; Palasciano, G.; Romagno, D.; Giannelli, G.; Napoli, N.; Plattella, M.S.; Cassano, P.; Gobbo, G.; Monti, V.; Raspanti, A.; Cuccorese, Null; Colombo, A.E.; Mandelli, G.; Spinzi, G.C.; Floridia, Null; Messina, V.; Bonfante, S.; Bellissima, P.; Toti, M.; Vecchiet, J.; Falasca, K.; Portelli, V.; Stefano, G. De; Pietromatera, G.; Viganò, P.; Re, T.; Andreoni, M.; Null, G.Raineri; Grossi, P.A.; Caputo, S.; Cassola, G.; Feasi, M.; Biagio, A. Di; Nicolini, L.; Giannini, E.G.; Corbo, M.; Foti, G.; Kunkar, A.; Caterini, L.; Migliorini, D.; Chiodera, A.; Calleri, G.; Spezia, C.; Framarin, L.; Null, M.Berrutti; Ciancio, A.; Baiguera, C.; Puoti, M.; Vento, S.; Contini, C.; Boccia, S.; Casiraghi, M.A.; Simone, L.; Tacconi, D.; Caremani, M.; Almi, P.; Chimenti, M.; Cosco, Null; Messeri, D.; Esperti, F.C.; Lomonaco, L.; Pazzi, P.; Fornari, F.; Comparato, G.; Casetti, T.; Foschi, F.G.; Samori, A.; Ferretti, E.; Marin, R.; Campo, N.; Testa, R.; Rizzo, S.Rosina, Floriano; Tosti, Maria Elena; Borghesio, Elisabetta; Masocco, Maria; Mele, Alfonso; Coppola, Carmine; Milella, Michele; Borgia, Guglielmo; Andreone, Pietro; Koch, Maurizio; Zignego, Anna Linda; Romano, Mario; Carrara, Maurizio; Almasio, Piero Luigi; Azzola, Emilio; Nardone, Gerardo; Benedetti, Antonio; Carosi, Giampiero; Mazzotta, Francesco; Sagnelli, Evangelista; Rizzetto, Mario; Mascolo, M. C.; Cursaro, C.; Scuteri, A.; Crespi, C.; Gianstefani, A.; Ranieri, J.; Monti, M.; Corti, G.; Blanc, P. L.; Baragli, F.; Bellentani, S.; Gasbarrini, A.; Pompili, M.; Mecenate, F.; Picardi, A.; Vespasiani, U.; Nosotti, Null; Gasbarrini, A.; Pompili, M.; Mecenate, F.; Null, A. Picardi; Nosotti, Null; Ricci, G. L.; Paffetti, A.; Mastropietro, C.; Moretti, A.; Spagnolo, A. L.; Puoti, C.; Bellis, L.; Regazzetti, A.; Maffezzini, E.; Pietrangelo, A.; Abbati, G.; Borghi, A.; Sardini, C.; Raimondo, G.; Scribano, L.; Martines, D.; Svegliati Baroni, G.; Faraci, G.; Schi anchi, S.; Fornaciari, G.; Massari, M.; Fabris, P.; Bertin, T.; Salvagnini, M.; Madonia, S.; Calì, A.; Civitavecchia, G.; Pirisi, M.; Smirne, C.; Andreoletti, M.; Morisco, F.; Caporaso, N.; Gentile, I.; Brancaccio, G.; Gaeta, G. B.; Liberti, A.; Iannece, M. D.; Rocco, A.; Federico, A.; Loguercio, C.; Riegler, G.; Esposito, P.; Fargion, S.; Fatta, E.; Masutti, F.; Bonaventura, M. E.; Autolitano, A.; Russello, M.; Bellia, A.; Toniutto, P.; Bitetto, D.; Pasulo, L.; Lucà, M. G.; Grattagliano, I.; Palasciano, G.; Romagno, D.; Giannelli, G.; Napoli, N.; Plattella, M. S.; Cassano, P.; Gobbo, G.; Monti, V.; Raspanti, A.; Cuccorese, Null; Colombo, A. E.; Mandelli, G.; Spinzi, G. C.; Floridia, Null; Messina, V.; Bonfante, S.; Bellissima, P.; Toti, M.; Vecchiet, J.; Falasca, K.; Portelli, V.; Stefano, G. De; Pietromatera, G.; Viganò, P.; Re, T.; Andreoni, M.; Null, G. Raineri; Grossi, PAOLO ANTONIO; Caputo, S.; Cassola, G.; Feasi, M.; Biagio, A. Di; Nicolini, L.; Giannini, E. G.; Corbo, M.; Foti, G.; Kunkar, A.; Caterini, L.; Migliorini, D.; Chiodera, A.; Calleri, G.; Spezia, C.; Framarin, L.; Null, M. Berrutti; Ciancio, A.; Baiguera, C.; Puoti, M.; Vento, S.; Contini, C.; Boccia, S.; Casiraghi, M. A.; Simone, L.; Tacconi, D.; Caremani, M.; Almi, P.; Chimenti, M.; Cosco, Null; Messeri, D.; Esperti, F. C.; Lomonaco, L.; Pazzi, P.; Fornari, F.; Comparato, G.; Casetti, T.; Foschi, F. G.; Samori, A.; Ferretti, E.; Marin, R.; Campo, N.; Testa, R.; Rizzo, S